Virtualization: An IT Prescription for Healthcare Providers

"I came from a couple of companies that utilized virtualization at very high levels," said Ray Todich, systems administrator for Associated Surgeons and Physicians. "So I'm very aware of the benefits, as far as administration, and the benefits of overall redundancy and activities -- the software and hardware used to allow high performance, high availability, access to people's data, and still allow security be put in place."

Healthcare providers know that technology can provide an answer to higher operating costs and ailing efficiencies within their organizations, but strict regulatory issues and other compliance matters have always proved to be tough obstacles. The security of patient health data, after all, must never be compromised in pursuit of greater efficiences.

A mid-market health services provider in Indiana, however, is offering up an example of how to make IT work for the industry.

Associated Surgeons and Physicians rapidly adopted client and server virtualization -- so fast, in fact, that it has gone from 100 percent physical to 100 percen virtualized infrastructure. Officials with Associated Surgeons and Physicians say they've not only met all compliance and efficiency goals, they been able to move quickly to mobile, adopt a bring your own device (BYOD) strategy and institute an advanced disaster recovery plan.

In this podcast, Ray Todich, systems administrator for Associated Surgeons and Physicians, shares his story on the best methods and technologies for better IT and business results in the healthcare services sector. Todich relates his experiences in allowing users to designate their own device choices while also gaining an ability to better manage sensitive data and creating a data-protection lifecycle approach.

Gardner: Let's take this first at a high level. A lot of organizations are looking to improve their IT and expand their business. They have various goals for compliance and making sure that their users are kept up to date on the latest and greatest in respective client technologies. Yet I'm curious what attracted you, at the beginning, to go to much higher total levels of server -- and then client -- virtualization.

Todich: When I first started here, the company was entirely physical. And as background, I came from a couple of companies that utilized virtualization at very high levels. So I'm very aware of the benefits, as far as administration, and the benefits of overall redundancy and activities -- the software and hardware used to allow high performance, high availability, access to people's data, and still allow security be put in place.

When I came in, it looked like something you might have seen maybe 15 years ago. There were a lot of older technologies in place. The company had a lot of external drives hanging off the servers for backups, and so on.

My first thing to implement was server virtualization, which at the time, was the vSphere 4.1 package. I explained to them what it meant to have centralized storage, what it meant to have ESX host, and how creating virtual machines would benefit them considerably over having physical servers in the infrastructure.

I gave them an idea on how nice it is to have alternate redundancy configured correctly, which is very important. When hardware drops out, RAID configuration goes south, or the entire server goes out, you've just lost an entire application -- or applications -- which in turn gives downtime.

I helped them to see the benefits of going virtualized, and at that time, it was solely for the servers.

Gardner: So over the past 10 or 15 years, as you pointed out, technology has just become so much more important to how a health provider operates, how they communicate to the rest of the world in terms of supplies, as well as insurance companies and payers, and so forth. Tell me a little bit about Associated Surgeons and Physicians. How big is the organization, what do you do, how have they been growing?

Todich: Pretty rapidly. Associated Surgeons and Physicians is a group of multi-specialty physicians and practices in Northeast Indiana and Northwest Ohio.

It began at the practice level, and then it really expanded. We're up to, I think, 14 additional locations and/or practices that have joined. We're also using an electronic medical record (EMR) application, given to us by Greenway, and that's a big one that comes in.

We're growing exponentially. It went from one or two satellite practices that needed to piggyback Greenway, to probably 13 or 14 of them, and this is only the beginning. With that type of growth rate, you have to concern yourself with the amount of money it costs to serve everybody. If you have one physical server that goes out, you affect hundreds of users and thousands of patients, doctors, and whatnot. It's a big problem, and that's where virtualization came in strong.

Gardner: When I go to the physician's office, and I just happened to be there yesterday, they've gotten so efficient at moving patients in and out that the scheduling is amazing. It has to be tight. Every minute is accounted for. Downtime is just very detrimental and backs up everything. You can think about it, I suppose, like an airport. If one flight gets backed up, the whole rest of the country does. Is that the case with you all there too, that this critical notion of time management is so paramount?

Todich: Oh, it's absolutely massive. If we have a snag somewhere, or even if our systems are running slow, then everything else runs slow. The ability that virtualization gives us is the core or heart of the entire infrastructure of the business. Without an efficient heart, blood doesn't move, and we have a bigger problem on our hands.

Gardner: How about this in terms of the size of the organization? How many seats are you accommodating in terms of client, and then what is it about an IT approach to an organization such as yours that also makes virtualization a good fit?

Todich: Right now, we have somewhere around 300 employees. As far as how many clients this overall organization has, it's thousands. We have lots of people who utilize the organization. The reality is that the IT staff here is used in a minimalist approach, which is one thing that I saw as well when I was coming into this.

One or even two persons to manage that many servers can be a nightmare, and on top of that, you try to do your best to help all the users. If you have 300-plus people and their desktops, printers, and so forth, so the overall infrastructure can be pretty intimidating, when you don't have a lot of people managing it.

Going virtual was a lifesaver. Everything is virtualized. You have a handful of physical ESX hosts that are managing anything, and everything is stored on centralized storage. It makes it considerably efficient as an IT administrator to utilize virtualization.

That's actually how we went into the adoption of VMware View, because of 300-plus users, and 300-plus desktops. At that point, it can be very hairy. At times, you have to try and divine what the right answer is. You have this important scenario going on, and you have this one and another one, and how do you manage them all. It becomes easier, when you virtualize everything, because you can get to everything very easily and cover everyone's desktops.

Gardner: And you have a double whammy here, because you're a mid-market size company and don't have a large, diversified IT staff to draw on. At the same time, you have branch offices and satellites, so you're distributed. To have people physically go to these places is just not practical. What is it about the distributed nature of your company that also makes virtualization and View 5.1 a good approach for a lean IT organization?

Todich: It helped us quite a bit, first and foremost, with the ability to give somebody a desktop, even if they were not physically connected to our network. That takes place a lot here. We have a lot of physicians who may be working inside of another hospital at the time.

Instead of them creating a VPN connection back into our organization, VMware View gave them the ability to have a client on their desktop, whether it be a PC, a MacBook, an iPod, an iPad, or whatever they have, even a phone, if they really want to go that route. They can connect anywhere, at anytime, as long as they have an Internet connection and they have the View client. So that was huge, absolutely huge.

They also have the ability to use PC-over-IP vs. RDP. That's very big for us as well. It keeps the efficiency and the speed of the machines moving. If you're in somebody else's hospital, you're bound to whatever network you are attached to there, so it really helps and it doesn't bother their stuff as much. All you're doing is borrowing their Internet and not anything else.

Gardner: Of course, we get back to that all-important issue for these physicians, surgeons, and practitioners about their time management, scheduling, understanding where they are supposed to be an hour from now, and in what office. All of that is now getting much more efficient as a result.

Todich: Yes, absolutely.

Gardner: Tell me a bit more about your footprint. We've spoken about vSphere 4.1 and adopting along the path of 5.1. You even mentioned View. What else are you running there to support this impressive capabilities set?

Todich: We moved from vSphere 4.1 to 5.1, and going to VMware View. We use 5.1 there as well. We decided to utilize the networking and security vCloud Networking package, which at the time was a package called vShield. When we bought it, everything changed, nomenclature-wise, and some of the products were dispersed, which actually was more to our benefit. We're very excited about that.

As far as our VDI deployment, that gave us the ability to use vShield Endpoint, which takes your antivirus and offloads it somewhere else on the network, so that your hosts are not burdened with virus scans and updates. That's huge.

The word huge doesn't even represent how everybody feels about that going away. It's not going away physically, just going away to another workhorse on the network so that the physicians, medical assistants, and everybody else isn't burdened with, "Oh, look, it's updating," or "Look, it's scanning something." It's very efficient.